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Empowered Girls Weekend Staff Application

Please complete the following form to apply.  
  
Description of Staff Roles on EGA Weekend:
Facilitator: Must be a certified WW Facilitator or FIT3
Four Aspect Women: Visual and speaking presentations to the participants representing the 4 aspects of self = Body / Heart / Mind / Spirit. *Costume is required for presentation.
Mentor: After EGA Weekend there is a 1 year commitment to mentor a participant and attend monthly EGA circles. * Completion of RYTP and Mentor Training Workshop is required.
General Staff: Various support staff duties.
Empowered Girl: Girl who has completed the EGA Training Weekend
 
* All EGA Weekend Staff members are required to have a criminal background check on file with CWSC. An authorization form will be sent to selected staff prior to the weekend.
 
EGA Weekend Staffing Fee = $125.00
 
EGA Staff Application Deadline = August 10, 2012

First Name*
Last Name*
Address*
Address 2
City*
State*
Zip Code*
Phone*
Alternate Phone Number
Email*
DOB*
Occupation*
Parent / Guardian Name (Required if you are under age 18)
Parent / Guardian Phone
Parent / Guardian Email
Health Concerns: (i.e., Pregnancy, High Blood Pressure, Back Problems)
Current Medications
Medical Certifications: I am an/a
List Credentials
CPR Certification Date
First Aid Certification Date
Completed Woman Within Weekend *
Mentor Training Date - Required for Mentors Only
RYTP Date
FIT Level
Facilitator Level
I am interested in the following role / position (please check all that apply)*
Gifts I bring to the EGA Weekend*
What I hope to gain by staffing*
Other ways I support my personal growth*
I have a friend/relative attending this weekend. Her name/relationship to me:

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